Methods of treating restenosis

ABSTRACT

Restenosis in a subject can be treated by administering to a tissue, e.g., a blood vessel, of the subject an agent that increases SERCA activity. For example, a stent that is coated with the agent can be introduced into a blood vessel.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims priority to U.S. Ser. No. 60/499,705, filed Sep.3, 2003, the contents of which are hereby incorporated by reference inits entirety.

BACKGROUND

Coronary artery disease (CAD) is the leading cause of mortality andmorbidity in the developed world. CAD is widely treated by implantationof stents (e.g., balloon stents) in the coronary artery. In-stentrestenosis, the recurrence of constriction of an artery followingefforts to dilate it, is a common side effect, affecting 20% to 40% ofpatients by 6 months after percutaneous coronary interventions (PCI),with neointimal hyperplasia being the primary cause.

Rapamycin (sirolimus), an antibiotic that inhibits cell migration andproliferation, is effective in reducing restenosis. However, prolongedexposure of smooth muscle cells to rapamycin results in the developmentof resistance to the drug (Luo et al., 1996, Mol. Cell. Biol. 16:6744-6751).

SUMMARY

We have discovered, inter alia, that expression (e.g., overexpression)of sarcoplasmic reticulum (SR) Ca²⁺ ATPase (SERCA) inhibits vascularsmooth muscle cell (VSMC) proliferation in vitro and reduces restenosisin vivo.

Accordingly, in one aspect, the disclosure features a method of treatingrestenosis in a subject, e.g., a human. The method includes: (a)identifying a subject in need of treatment for restenosis (e.g., asubject who has had angioplasty, or a subject who has had a stent placedin a body cavity, such as a blood vessel); and administering to atissue, e.g., a blood vessel, of the subject an agent that increasesSERCA activity in an amount sufficient to reduce or prevent restenosisin the subject. In a preferred embodiment, SERCA is SERCA1, e.g.,SERCA1a or SERCA1b; SERCA2, e.g., SERCA2a or SERCA2b; or SERCA3, butpreferably SERCA2a. The agent may also be administered in an amounteffective to prevent endothelial cell proliferation or neointimaformation.

The agent can be, e.g., a SERCA polypeptide or a functional fragment,variant or analog thereof having a SERCA activity, e.g., ATPaseactivity; a peptide or protein agonist of SERCA that increases theactivity, e.g., the ATPase activity of SERCA (e.g., by increasing orstabilizing binding of SERCA to a binding partner, e.g., phospholamban);a small molecule that increases expression of SERCA, e.g., by binding tothe promoter region of the SERCA gene; an antibody, e.g., an antibody(e.g., an intrabody) that binds to and stabilizes or assists the bindingof SERCA to a SERCA binding partner (e.g., a SERCA binding partnerdescribed herein); or a nucleotide sequence encoding a SERCA polypeptideor functional fragment or analog thereof. The nucleotide sequence can bea genomic sequence or a cDNA sequence. The nucleotide sequence caninclude: a SERCA coding region; a promoter sequence, e.g., a promotersequence from a SERCA gene or from another gene; an enhancer sequence;untranslated regulatory sequences, e.g., a 5′ untranslated region (UTR),e.g., a 5′ UTR from a SERCA gene or from another gene, a 3′ UTR, e.g., a3′ UTR from a SERCA gene or from another gene; a polyadenylation site;an insulator sequence. In another embodiment, the level of SERCA proteinis increased by increasing the level of expression of an endogenousSERCA gene, e.g., by increasing transcription of the SERCA gene orincreasing SERCA mRNA stability. In a preferred embodiment,transcription of the SERCA gene is increased by: altering the regulatorysequence of the endogenous SERCA gene, e.g., by the addition of apositive regulatory element (such as an enhancer or a DNA-binding sitefor a transcriptional activator); the deletion of a negative regulatoryelement (such as a DNA-binding site for a transcriptional repressor)and/or replacement of the endogenous regulatory sequence, or elementstherein, with that of another gene, thereby allowing the coding regionof the SERCA gene to be transcribed more efficiently.

In a preferred embodiment, the agent is a vector that includes a nucleicacid encoding SERCA, e.g., SERCA1, e.g., SERCA1a or SERCA1b; SERCA2,e.g., SERCA2a or SERCA2b; or SERCA3, preferably a human SERCA. Thevector can be any vector suitable for gene transfer. For example, thevector can be an adenoviral vector, e.g., recombinant type 2 or type 5adenoviral vector; an adeno-associated virus, e.g., adeno-associatedvirus type 1, 2, 3, 4, 5 or 6, a lentiviral vector, or plasmid-basedvector. The vector is preferably an adeno-associated virus-based vectoror a lentivirus. Other vectors suitable for gene transfer, e.g., tocardiovascular tissue, are known in the art.

In a preferred embodiment, the SERCA encoding nucleic acid is under thecontrol of a heterologous regulatory region, e.g., a heterologouspromoter. The promoter can be, e.g., a smooth muscle specific promoter,such as a smooth muscle alpha actin promoter, SM22a promoter; cardiacspecific promoter, such as a cardiac myosin promoter (e.g., a cardiacmyosin light chain 2v promoter), troponin T promoter, or BNP promoter.The promoter can also be, e.g., a viral promoter, such as CMV promoter.The promoter can be an inducible promoter, e.g., one regulatable by anexogenous agent, e.g., FK506, FK1012, a steroid, or tetracycline.

The agent can be delivered by direct administration, e.g., injection(e.g., intra arterial, iv or im). In one embodiment, the agent isdelivered directly to an affected vessel, e.g., artery. The agent can becoupled to a second agent, e.g., a delivery agent (e.g., an agent thatprotects the agent from degradation) or a targeting agent (e.g., fortargeting to the vessel or targeting to the inside of a cell such as asmooth muscle cell, e.g., a liposome).

In a preferred embodiment, the subject is a human, e.g., a male orfemale human. For example, the human can be between 20-40 years of age,40-60 years of age, or 60-70 years of age, or greater than 70 years ofage. In some embodiments, the subject is identified by evaluation of thesubject's health history, conducting a physical examination, or byperforming clinical testing. A preferred subject is one who hasundergone or will undergo (e.g., within 1, 2, 3, 5, 10, 15, 30, or more,days) angioplasty, balloon angioplasty, insertion of a prosthesis,insertion of a graft, insertion of a stent, catheterization, or arterialblockage evaluation. In one embodiment, the restenosis occurs afterangioplasty. In another embodiment, the restenosis occurs after vascularstent placement. The blood vessel is preferably a coronary artery, andcan also be, for example, a peripheral artery or a cerebral artery.

In a preferred embodiment, the method includes implanting a stent in anafflicted blood vessel of the subject, wherein the stent is coated with,or contains, the agent that increases SERCA activity, e.g., an agentdescribed herein. In a preferred embodiment, the method includesimplanting in a blood vessel of the subject a stent coated with, orcontaining, SERCA2a or an expression vector that includes a SERCA2aencoding nucleic acid.

In another embodiment, the agent is an agent that decreasesphospholamban activity. An agent that inhibits phospholamban levelsand/or activity can be one or more of: a phospholamban binding protein,e.g., a soluble phospholamban binding protein that binds and inhibits aphospholamban activity, e.g., SERCA2 binding activity; an antibody thatspecifically binds to the phospholamban protein, e.g., an antibody thatdisrupts phospholamban's ability to bind SERCA; a mutated inactivephospholamban or fragment thereof which, e.g., binds to a phospholambanbinding partner (e.g., SERCA) but disrupts a phospholamban activity; aphospholamban nucleic acid molecule that can bind to a cellularphospholamban nucleic acid sequence, e.g., mRNA, and inhibit expressionof the protein, e.g., an antisense molecule, phospholamban ribozyme oriRNA agent; an agent which decreases phospholamban gene expression,e.g., a small molecule which binds the promoter of phospholamban anddecreases phospholamban gene expression. In another preferredembodiment, phospholamban is inhibited by decreasing the level ofexpression of an endogenous phospholamban gene, e.g., by decreasingtranscription of the phospholamban gene. In a preferred embodiment,transcription of the phospholamban gene can be decreased by: alteringthe regulatory sequences of the endogenous phospholamban gene, e.g., bythe addition of a negative regulatory sequence (such as a DNA-bidingsite for a transcriptional repressor), or by the removal of a positiveregulatory sequence (such as an enhancer or a DNA-binding site for atranscriptional activator). activity, e.g., antisense nucleic acid atleast partially complementary to a phospholamban DNA sequence,preferably a human phospholamban DNA sequence.

In one embodiment, the method includes preconditioning the heart of thesubject; and delivering the agent into a cardiovascular cell of thepreconditioned heart, wherein the flow of blood through the heart isreduced during the delivery of the agent. In a preferred embodiment, theagent is a nucleic acid (e.g., a SERCA2a encoding nucleic acid)administered into a vessel of the preconditioned heart, wherein the flowof blood through the heart is reduced during the delivery of the agent.In a preferred embodiment, preconditioning is accomplished using acatheter, e.g., a balloon catheter. “Preconditioning” refers to anaturally occurring protective mechanism by which a brief period ofischemia protects a tissue against adverse effects of a subsequent,prolonged period of ischemia. In the context of this method,“preconditioning” means inducing a state in which the heart is moreresistant to damage from a second stoppage of flow. Preconditioning theheart muscle can be accomplished by a brief occlusion of a cardiacvessel (e.g., the left anterior descending artery) resulting insubstantially increased expression of a gene subsequently transducedinto the heart muscle. Preconditioning in the present method can beinduced with a pharmacological agent, a mechanical manipulation, e.g., acatheter (e.g., a balloon catheter), or other surgical method.

In a preferred embodiment, the method includes evaluating the subjectfor a cardiovascular parameter, e.g., lumen loss, heart rate, heartcontractility, ventricular function, e.g., left ventricularend-diastolic pressure (LVEDP), left ventricular systolic pressure(LVSP), Ca²⁺ metabolism, e.g., intracellular Ca²⁺ concentration or peakor resting Ca²+, force generation, relaxation and pressure of the heart,a force frequency relationship, cardiocyte survival or apoptosis or ionchannel activity, e.g., sodium calcium exchange, sodium channelactivity, calcium channel activity, sodium potassium ATPase pumpactivity, activity of myosin heavy chain, troponin I, troponin C,troponin T, tropomyosin, actin, myosin light chain kinase, myosin lightchain 1, myosin light chain 2 or myosin light chain 3, IGF-1 receptor,PI3 kinase, AKT kinase, sodium-calcium exchanger, calcium channel (L andT), calsequestrin or calreticulin. The evaluation can include performingangiography (e.g., quantitative angiography) and/or intravascularultrasound (IVUS), e.g., before, after, or during the treatment.

In a preferred embodiment, a pharmaceutical composition including one ormore of the agents described herein is administered in apharmaceutically effective dose.

In a preferred embodiment, the administration of an agent whichincreases SERCA expression, levels or activity can be initiated: whenthe subject begins to show signs of restenosis, e.g., as evidenced by andecrease of more than 5, 10, 20, or 30% in lumen; when a coronaryvascular condition is diagnosed; at the time a treatment for a coronaryvascular condition is begun or begins to exert its effects (e.g., duringsurgery to implant a stent); or generally, as is needed to maintainheart function.

The period over which the agent is administered (or the period overwhich clinically effective levels are maintained in the subject) can belong term, e.g., for six months or more or a year or more, or shortterm, e.g., for less than a year, six months, one month, two weeks orless. Although an agent can be administered in a short term, or once,expression of a nucleic acid in the agent can be sustained, e.g., for atleast one, two, three, four, or six months. Promoters can be selectedthat are inducible, e.g., to limit or prolong the period of expression.

In another aspect, the disclosure features a stent coated with, orcontaining an agent that can increase SERCA expression, e.g., an agentdescribed herein. For example, the agent is a nucleic acid. The nucleicacid can be packaged in a viral or non-=viral particle. The stent caninclude, e.g., at least 10⁹, 1×10¹⁰, 1×10¹¹, 10¹², 1×10¹³, 1×10¹⁴,1×10¹⁵, or 1×10¹⁶ units (e.g., particles), or, for example, between1×10⁹ to 1×10¹⁸ or 1×10¹¹ to 1×10¹⁶.

In a preferred embodiment, the agent is a nucleic acid encoding SERCA,e.g., SERCA1, e.g., SERCA1a or SERCA1b; SERCA2, e.g., SERCA2a orSERCA2b; or SERCA3. In a preferred embodiment, the SERCA encodingnucleic acid is under the control of a heterologous regulatory region,e.g., a heterologous promoter. The promoter can be, e.g., a smoothmuscle specific promoter, such as a smooth muscle alpha actin promoter,SM22a promoter; cardiac specific promoter, such as a cardiac myosinpromoter (e.g., a cardiac myosin light chain 2v promoter), troponin Tpromoter, or BNP promoter. The promoter can also be, e.g., a viralpromoter, such as CMV promoter.

In another embodiment, the agent is an antisense nucleic acid at leastpartially complementary to a phospholamban DNA sequence, preferably ahuman phospholamban DNA sequence.

Although a stent described herein is preferably for use in a bloodvessel, it can also be used in other tissues such as those forming acavity, orifice or duct, in which restenosis can occur. Causes of suchrestenosis include, for example, organ transplantation.

In some embodiments, a stent described herein, in addition to beingcoated with, or containing, an agent that increases SERCA expression,can also be coated with a second therapeutic agent. For example, thestent can also contain one or more of: rapamycin, taxol andactinomycin-D.

In another aspect, the disclosure features a kit. The kit includes: (a)an agent that increases SERCA, e.g., SERCA2a, activity (e.g., SERCA, anucleic acid encoding SERCA, or an antisense nucleic acid at leastpartially complementary to a phospholamban nucleic acid), and (b)informational material relating to restenosis. Optionally, the kitincludes a stent containing, or coated with, the agent. Theinformational material can include instructions for using the kit toprevent or treat restenosis.

In another aspect, the disclosure features a stent that includes anantibody (e.g., a full length antibody or an antibody fragment, e.g., aFab, Fc, scFv, etc). The antibody binds to a coat protein of a viralparticle, e.g. a viral particle described herein. The stent can be usedto deliver viral particles that contain any nucleic acid of interest,e.g., a therapeutic nucleic acid, e.g., a nucleic acid described herein.For example, the antibody can have an antigen binding site thatinteracts with a coat protein of an adenovirus, or an adeno-associatedvirus, or a lentivirus, e.g., a retrovirus.

As used herein, a “stent” is a medical device configured forimplantation in a body lumen to prevent or inhibit the closing of thelumen. A stent can be configured to be implanted in, e.g., a bloodvessel such as an artery, or other body cavity, orifice or duct, such asa ureter. A stent is typically made of biocompatible metal or plastic.

As used herein, a stent “coated with or containing” an agent means astent having the agent either affixed to its surface or contained withinit, so as to permit release of the agent from the stent and, hence,delivery of the agent to tissue in proximity with the stent. A stent canalso include a slow-release formulation of the agent, e.g., to releasethe agent over time. An agent can be affixed by non-covalentinteractions or by covalent interactions, e.g., covalent interactionsthat are disrupted overtime.

Ability of an agent to function to a required degree can be to an extentdetectable as significant by one skilled in the art or to astatistically significant degree.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a set of traces showing the ATP- and tBuBHQ-induced increasein cytosolic [Ca2+] in control conditions (top) or in cells infectedwith adenovirus SERCA2a vector (Ad S2a) (bottom).

FIG. 2 is a set of graphs and micrographs showing the effects of SERCA2aon VSMC. SERCA 2a expression in growing VSMC blocked proliferation. (A)monitoring of adenoviral infection by GFP fluorescence (485/530 nm) incultured VSMC (D0, day of infection; D4, day 4 after infection); (B)analysis of expression of SERCA2 by Western blot at D4 in Ad-infectedand control VSMC; 40 μg of total protein extract were loaded on eachline; (C) effect of infection by Ad-βGal and Ad-S2a on proliferation ofVSMC; (D) double immunolabelling with a-SERCA2a (red) and a-PCNA(purple); GFP expression vas monitored by fluorescence 485/530nm.

FIG. 3 illustrates the effect of SERCA2a expression on NFAT nucleartranslocation in one implementation. (A) immunolabelling with a-NFAT:a—Ad bGal infected, b—control, c—Ad S2a infected, d—control+CsA (5 μM,24 h), e—Ad S2a infected+Tg (1 μM, 1 h), f—control+Tg (1 μM, 1 h). (B)western blot analysis of cytosolic and nuclear extract prepared fromcontrol and Ad-infected SMC. Immnohybridisation with a-NFATc1. (C)analysis of NFAT-binding activities from control and Ad-infected SMC.EMSA experiments were performed with the P32-labelled NFAT probe.

FIG. 4 provides a histogram showing the intima thickness under variousconditions.

DETAILED DESCRIPTION

The restenosis rates for the most common treatments for coronaryvascular conditions are shown in Table 1. TABLE 1 RESTENOSIS RATERapamycin Condition Angioplasty Stent Coated Stents MyocardialInfarction 30% 20% <10% Vein Graft Occlusion 50-60% 30% — ChronicCoronary Artery 40% 20% <10% Disease

Proliferation of vascular smooth muscle cells (VSMC) is thought to be akey factor in the development of atherosclerosis and restenosis afterballoon injury and is associated with dedifferentiation of the VSMC.Alterations in expression of proteins involved in calcium homeostasishave been reported. Differentiated smooth muscle cell exhibits differentCa2+ signals including localized transient release through the ryanodinereceptors in the form of Ca2+ sparks and Ca2+ waves of differentamplitude and frequency. Proliferation of VSMC is accompanied byreplacement of the L-type Ca2+ channels by the T-type, loss of ryanodinereceptors and of SERCA2a, and enhanced capacitative Ca2+ entry.

The inventors have found that increasing SERCA (e.g., SERCA2a) activityin a subject can prevent or reduce restenosis. The methods describedherein, e.g., methods of preventing or reducing restenosis by increasingSERCA activity, e.g., by gene transfer of SERCA, can improve calciumhandling without causing apoptosis. Other advantages of the methods andcompositions described herein include: decreased proliferation of smoothmuscle cells without causing apoptosis and cell death; lack of toxicityin other tissues; beneficial effects within the myocardium; preventionof smooth muscle death and maintenance of the integrity of the wall.

Sarcoplamic Reticulum (SR) Ca²⁺ ATPase (SERCA) The sarcoplasmicreticulum (SR) is an internal membrane system, which plays a criticalrole in the regulation of cytosolic Ca²⁺ concentrations and thus,excitation-contraction coupling in muscle. In cardiac cells release ofCa²⁺ from the SR leads to contraction whereas in smooth muscle cells itinduces vasorelaxation through activation of Ca²⁺ activated potassiumchannels and hyperpolarisation of the cell. Control of the cytosolicCa²⁺ concentration involves the active re-uptake of Ca²⁺ into the SRlumen by a Ca²⁺-ATPase. In cardiac and smooth muscles, the SRCa²⁺-ATPase activity (SERCA2a) is under reversible regulation byphospholamban.

Defects in SR Ca²⁺ cycling have a crucial role in progression of cardiachypertrophy and failure. Cardiac hypertrophy as well as its deleteriouseffects on contractile function can be prevented by activating SR Ca²⁺uptake either by SERCA2a gene transfer or by decreasing the inhibitoryeffect of phospholamban on SERCA 2a (reviewed in Kaprielian et al.,2002, Basic Res Cardiol. 97 Suppl 1:1136-45).

The sequence of human SERCA proteins are known in the art (see, e.g.,Lytton and MacLennan, 1988, J. Biol. Chem. 263(29), 15024-15031; GenbankAccession Nos. NP_(—)001672; P16615; NP_(—)733765).

Exemplary Gene Transfer

The nucleic acids described herein, e.g., a SERCA encoding nucleic acid,can be incorporated into a gene construct to be used as a part of a genetherapy protocol. Methods for gene transfer in vivo are known in theart. Approaches include insertion of the subject gene in viral vectorsincluding recombinant retroviruses, adenovirus (e.g., replicationdeficient, first generation, or gutted, second generation, adenovirus),adeno-associated virus (e.g., any of types 1-6), lentivirus, and herpessimplex virus-1, or recombinant bacterial or eukaryotic plasmids. Viralvectors transfect cells directly; plasmid DNA can be delivered with thehelp of, for example, cationic liposomes (lipofectin) or derivatized(e.g. antibody conjugated), polylysine conjugates, gramacidin S,artificial viral envelopes or other such intracellular carriers, as wellas direct injection of the gene construct or CaPO₄ precipitation carriedout in vivo.

Gene transfer into cardiovascular tissue, for example, has beensuccessful using adenovirus (Ad) vectors with strong, non-tissuespecific gene expression cassettes driven by cytomegalovirus (CMV) orRous sarcoma virus (RSV) promoters. Clinical trials involvingtransduction of cardiac cells with viral vectors to deliver angiogenicfactors such as vascular endothelial cell growth factor (VEGF),fibroblast growth factor (FGF) and hepatocyte growth factor (HGF) havebeen ongoing. Intra-aorta or intracoronary injection of virus has beenused in vivo in animal models. In one study, intracardiac injection ofan Ad-SERCA2a viral vector in rats was sufficient to inducephysiological improvement in calcium handling. See Miyamoto et al.,2000, Proc. Natl. Acad. Sci. USA 97:793-98. Adenoviral vectors have alsobeen used in vivo to express β2 adrenergic receptor (β-AR) (see Mauriceet al. 1999, J. Clin. Invest. 104:21-9 and Shah et al., 2001,Circulation 103:1311). As is known from studies on cystic fibrosis,transduction of all cells in a tissue is not required for improvedfunction. For example, expression of the wild type sodium channel in asfew as 6-10% of cells within an epithelial sheet lacking a functionalsodium channel is sufficient for normal sodium ion transport (Johnson etal, 1992, Nat. Genet 2:21-5). This is known as the bystander effect.

Tissue specific promoters have been used to increase specificity ofmyocardial gene expression (Rothmann et al., 1996, Gene Ther. 3:919-26).Another strategy to restrict expression of transferred genes to theheart has involved direct injection of a viral vector into themyocardium (Gutzman et al, 1993, Cric. Res. 73: 1202-7; French et al.,1994, Circulation. 90:2414-24). Another attempt involvedintrapericardial virus vector injection combined with proteinasetreatment (Fromes et al., 1999, Gene Ther. 6:683-8). These manipulationsachieved local gene delivery, although with some drawbacks, due to alack of intense viral vector diffusion.

The efficiency of cardiomyocyte gene delivery by an adeno-associatedvirus (AAV) vector was documented in vitro using cultured rat neonatalcells, as well as in an ex vivo system using rat papillary muscleimmersion (Maeda et al., 1998, J. Mol. Cell. Cardiol. 30:1341-8). Exvivo AAV vector transfer followed by syngeneic heart transplantation wasreported to achieve high efficiency marker gene expression (Svensson etal., 1999, Circulation. 99:201-5).

Methods of achieving a high level of in vivo cardiotopic gene transferwith high consistency (average 60-70% of cardiac myocytes) aredescribed, e.g., in US Published Application 20020032167. Other methodsfor the preparation and use of viral vectors are described in WO96/13597, WO 96/33281, WO 97/15679, and Trapnell et al., 1994, Curr.Opin. Biotechnol. 5(6):617-625; Ardehali et al., 1995, J. Thorac.Cardiovasc. Surg. 109:716-720; Dalesandro et al., 1996, J. Thorac.Cardiovasc. Surg. 111:416-422; Sawa et al., 1995, Circ 92, 11479-11482;Lee et al., 1996, J. Thorac. Cardiovasc. Surg. 111, 246-252; Yap et al.,19996, Circ. 94, I-53; and Pellegrini et al., 1998, Transpl. Int. 11,373-377.

A subject polynucleotide can also be administered using a non-viraldelivery vehicle. “Non-viral delivery vehicle” (also referred to hereinas “non-viral vector”) as used herein is meant to include chemicalformulations containing naked or condensed polynucleotides (e.g., aformulation of polynucleotides and cationic compounds (e.g., dextransulfate)), and naked or condensed polynucleotides mixed with an adjuvantsuch as a viral particle (i.e., the polynucleotide of interest is notcontained within the viral particle, but the transforming formulation iscomposed of both naked polynucleotides and viral particles (e.g.,adenovirus particles) (see, e.g., Curiel et al. 1992 Am. J. Respir. CellMol. Biol. 6:247-52)). Thus “non-viral delivery vehicle” can includevectors composed of polynucleotides plus viral particles where the viralparticles do not contain the polynucleotide of interest. “Non-viraldelivery vehicles” include bacterial plasmids, viral genomes or portionsthereof, wherein the polynucleotide to be delivered is not encapsidatedor contained within a viral particle, and constructs comprising portionsof viral genomes and portions of bacterial plasmids and/orbacteriophages. The term also encompasses natural and synthetic polymersand co-polymers. The term further encompasses lipid-based vehicles.Lipid-based vehicles include cationic liposomes such as disclosed byFelgner et al (U.S. Pat. Nos. 5,264,618 and 5,459,127; PNAS84:7413-7417, 1987; Annals N.Y. Acad. Sci. 772:126-139, 1995); they mayalso consist of neutral or negatively charged phospholipids or mixturesthereof including artificial viral envelopes as disclosed by Schreier etal. (U.S. Pat. Nos. 5,252,348 and 5,766,625).

Non-viral delivery vehicles include polymer-based carriers.Polymer-based carriers may include natural and synthetic polymers andco-polymers. Preferably, the polymers are biodegradable, or can bereadily eliminated from the subject. Naturally occurring polymersinclude polypeptides and polysaccharides. Synthetic polymers include,but are not limited to, polylysines, and polyethyleneimines (PEI;Boussif et al., PNAS 92:7297-7301, 1995) which molecules can also serveas condensing agents. These carriers may be dissolved, dispersed orsuspended in a dispersion liquid such as water, ethanol, salinesolutions and mixtures thereof. A wide variety of synthetic polymers areknown in the art and can be used.

In clinical settings, the gene delivery systems for the therapeutic genecan be introduced into a patient by any of a number of methods, each ofwhich is familiar in the art. For instance, a pharmaceutical preparationof the gene delivery system can be introduced systemically, e.g. byintravenous injection, and specific transduction of the protein in thetarget cells occurs predominantly from specificity of transfectionprovided by the gene delivery vehicle, cell-type or tissue-typeexpression due to the transcriptional regulatory sequences controllingexpression of the receptor gene, or a combination thereof. In otherembodiments, initial delivery of the recombinant gene is more limitedwith introduction into the animal being quite localized. For example,the gene delivery vehicle can be introduced by catheter (see U.S. Pat.No. 5,328,470) or by stereotactic injection (e.g. Chen et al. (1994)PNAS 91: 3054-3057).

The pharmaceutical preparation of the gene therapy construct can consistessentially of the gene delivery system in an acceptable diluent, or cancomprise a slow release matrix in which the gene delivery vehicle isimbedded. Alternatively, where the complete gene delivery system can beproduced in tact from recombinant cells, e.g. retroviral vectors, thepharmaceutical preparation can comprise one or more cells which producethe gene delivery system.

The polynucleotide to be delivered can also be formulated as a DNA- orRNA-liposome complex formulation. Such complexes comprise a mixture oflipids which bind to genetic material (DNA or RNA) by means of cationiccharge (electrostatic interaction). Cationic liposomes which may be usedin the present invention include 3β-[N-(N′,N′-dimethyl-aminoethane)--carbamoyl]-cholesterol (DC-Chol),1,2-bis(oleoyloxy-3-trimethylammonio-propane (DOTAP) (see, for example,WO 98/07408), lysinylphosphatidylethanola- mine (L-PE), lipopolyaminessuch as lipospermine,N-(2-hydroxyethyl)-N,N-d-imethyl-2,3-bis(dodecyloxy)-1-propanaminiumbromide, dimethyl dioctadecyl ammonium bromide (DDAB),dioleoylphosphatidyl ethanolamine (DOPE), dioleoylphosphatidyl choline(DOPC), N(1,2,3-dioleyloxy) propyl-N,N,N-triethylammonium (DOTMA),DOSPA, DMRIE, GL-67, GL-89, Lipofectin, and Lipofectamine (Thiery et al.(1997) Gene Ther. 4:226-237; Felgner et al., Annals N.Y. Acad. Sci.772:126-139, 1995; Eastman et al., Hum. Gene Ther. 8:765-7.73, 1997).Polynucleotide/lipid formulations described in U.S. Pat. No. 5,858,784can also be used in the methods described herein. Many of these lipidsare commercially available from, for example, Boehringer-Mannheim, andAvanti Polar Lipids (Birmingham, Ala.). Also encompassed are thecationic phospholipids found in U.S. Pat. Nos. 5,264,618, 5,223,263 and5,459,127. Other suitable phospholipids which may be used includephosphatidylcholine, phosphatidylserine, phosphatidylethanolamine,sphingomyelin, phosphatidylinositol, and the like. Cholesterol may alsobe included.

Exemplary Methods of Treatment

The present invention includes within its scope the use of a compositionfor treating restenosis, comprising an agent that increases SERCA, e.g.,SERCA2a, activity. The agent can be, e.g., a nucleic acid encoding SERCAin the form of expression vector containing a DNA encoding SERCA2,preferably SERCA2a, in association with a pharmaceutically acceptablecarrier, excipient or other additive, if necessary. In anotherembodiment, the agent is an antisense nucleic acid at least partiallycomplementary to a phospholamban nucleic acid sequence in associationwith a pharmaceutically acceptable carrier, excipient or other additive,if necessary. Examples of suitable carriers, excipients, and diluentsare lactose, dextrose, sucrose, sorbitol, mannitol, starches, gumacacia, alginates, gelatin, calcium phosphate, calcium silicate,cellulose, methyl cellulose, microcrystalline cellulose,polyvinylpyrrolidone, water, methylhydroxybenzoates,propylhydroxybenzoates, talc, magnesium stearate and mineral oil. Thecompositions may additionally include lubricating agents, wettingagents, flavoring agents, emulsifiers, preservatives and the like.

The compositions described herein can be formulated so as to providequick, sustained or delayed release of the active ingredient afteradministration to a patient by employing any of the procedures wellknown in the art.

In a preferred embodiment, the agent is formulated for intracardiac orintra vessel administration. Such direct administration can beaccomplished thorough, e.g., coating the agent on a stent to beimplanted into a vessel of the subject. The effective amount of anucleic DNA encoding SERCA2a as an active ingredient may range fromabout 0.05 to 500 mg/kg, preferably 0.5 to 50 mg/kg body weight, and canbe administered in a single dose or in divided doses. However, it shouldbe understood that the amount of the active ingredient actuallyadministered ought to be determined in light of various relevant factorsincluding the condition to be treated, the age and weight of theindividual patient, and the severity of the patient's symptom; and,therefore, the above dose should not be intended to limit the scope ofthe invention in any way.

Exemplary Stents

The invention also includes a stent coated with, or containing, an agentthat increase SERCA, preferably SERCA2a, activity, e.g., an agentdescribed herein. Methods for preparing stents (both biodegradable andnon-biodegradable) for delivering a therapeutic agent are well known(see, e.g., U.S. Pat. Nos. 5,163,952, 5,304,121, 6,391,052, 6,387,124,6,379,382, and 6,358,556, 6,605,110, 6,605,114, 6,572,645, 6,569,194,6,545,748, 6,541,116, 6,527,801, 6,506,437). In one embodiment, a stentdescribed herein is coated with a therapeutic agent, e.g., an agentdescribed herein, such as a SERCA nucleic acid described herein, usingtechniques known in the art.

In one embodiment, the stent is a stainless steel stent or nytinol meshlike devices. For example, a stent can be delivered into the coronaryartery on a catheter during a PCI procedure (percutaneous coronaryintervention). A stent can be deployed in the artery by either expansionby a balloon or by a self expanding delivery design. Exemplarycommercially available stents include Gianturco-Roubin Stents (e.g.,from Cook Cardiology), Multilink, Duet, Tetra, Penta, Zeta Stents(e.g.,from Guidant); Nir, Wall Stents, Taxus (e.g., from SCIMED/BostonScientific), GFX/S series Stents (e.g., from Medtronic/AVE), velocityand Cypher stents (e.g., from Johnson & Johnson/Cordis)

For example, a stent can be coated with a polymeric cation that canmediate nucleic acid condensation or compaction, e.g., as described inU.S. Pat. No. 6,596,699. Linear polycations such as poly-L-lysine,polyornithine, polyarginine and the like can be used. The polymers maybe homopolymers, such as polylysine, polyornithine, or polyarginine, ormay be heteropolymers, including random polymers formed of lysine,ornithine, arginine and the like. More complex molecules may also beemployed as polycations, such as branched or linear polyethylenimine andthe like. Any of a variety of naturally occurring nucleic acid bindingagents may be employed, such as spermine or spermidine, and areincluding within the definition of polycation. Protamine can similarlybe employed, as can any of a variety of histones. Polyamidoaminedendrimers may similarly be employed, wherein terminal amino groups bindthe nucleic acid by electrostatic means, resulting in positively chargedcondensates. The polycation may be specifically modified to provideoptimal characteristics to form the desired condensate. For example, arepeating lysine chain of 18 residues followed by a tryptophan and analkylated cysteine residue has been reported to form condensates withproperties at least equal to polylysine. McKenzie et al., J. PeptideRes. 54:311-318 (1999). In general, the polycation is positivelycharged, and has a net positive charge at about pH 6 to about 8 or hasmore than about five positively charged residues. The polycation has ahigher number of positive charges compared to the number of negativecharges. A polycation includes natural nucleic acid-binding proteins andrecombinant nucleic acid-binding protein, such as homo- orhetero-polymers of amino acids or synthetic compounds that bind to oneor more nucleic acid sequences found within natural or recombinantnucleic acid molecules and results in nucleic acid condensation.

An additional method of coating a therapeutic nucleic acid onto amedical device such as a stent involves coating the medical device witha swellable hydrogel polymer as described, e.g., in U.S. Pat. Nos.5,674,192 or 6,409,716. The hydrogel coating is characterized by theability to incorporate a substantial amount of the nucleic acid,typically in aqueous solution form, and is swellable such that theaqueous solution can be effectively squeezed out of the coating whenpressure is applied, e.g., by inflation or expansion of the stent.Administration of the drug in this way enables the drug to besite-specific, such that release of high concentrations can be limitedto direct application to. the affected tissue.

Other methods of coupling a therapeutic agent, such nucleic acid, to astent or other medical device are known in the art, see for example,U.S. Pat. Nos. 6,024,918, 6,506,408; 5,932,299.

In some embodiments, a stent described herein, in addition to beingcoated with, or containing, an agent that increases SERCA expression,can also be coated with a second therapeutic agent. For example, thestent can also contain one or more of: rapamycin, taxol andactinomycin-D, a thrombin inhibitor, an antithrombogenic agent, athrombolytic agent, a fibrinolytic agent, a vasospasm inhibitor, acalcium channel blocker, a vasodilator, an antihypertensive agent, anantimicrobial agent, an antibiotic, an inhibitor of surface glycoproteinreceptors, an antiplatelet agent, an antimitotic, a microtubuleinhibitor, an antisecretory agent, an actin inhibitor, a remodelinginhibitor, an antisense nucleotide, an antimetabolite, anantiproliferative, an anticancer chemotherapeutic agent, ananti-inflammatory steroid or non-steroidal antiinflammatory agent, animmunosuppressive agent, a growth hormone antagonist, a growth factor, adopamine agonist, a radiotherapeutic agent, a peptide, a protein, anenzyme, an extracellular matrix component, a free radical scavenger, achelator, an antioxidant, an antipolymerase, an antiviral agent, aphotodynamic therapy agent, and a gene therapy agent, e.g., a secondgene therapy agent. In one embodiment, the subject is also administereda second agent, e.g., separately from the agent that increases SERCAactivity. For example, the subject can be orally administered aspirin oran oral anti-platelet drug (e.g., PLAVIX® or TICLID®).

Exemplary Kits

The agent described herein (e.g., SERCA nucleic acid or polypeptide) canbe provided in a kit. The kit includes (a) the agent, e.g., acomposition that includes the agent, (b) informational material, andoptionally (c) a stent. The informational material can be descriptive,instructional, marketing or other material that relates to the methodsdescribed herein and/or the use of the agent for the methods describedherein. For example, the informational material relates to restenosis.

In one embodiment, the informational material can include instructionsto administer the agent in a suitable manner to perform the methodsdescribed herein, e.g., in a suitable dose, dosage form, or mode ofadministration (e.g., a dose, dosage form, or mode of administrationdescribed herein). In another embodiment, the informational material caninclude instructions to administer the agent to a suitable subject,e.g., a human, e.g., a human having, or at risk for, restenosis. Forexample, the material can include instructions to administer the agentto a subject who has had, is having or will have angioplasty.

The informational material of the kits is not limited in its form. Inmany cases, the informational material, e.g., instructions, is providedin printed matter, e.g., a printed text, drawing, and/or photograph,e.g., a label or printed sheet. However, the informational material canalso be provided in other formats, such as computer readable material,video recording, or audio recording. In another embodiment, theinformational material of the kit is contact information, e.g., aphysical address, email address, website, or telephone number, where auser of the kit can obtain substantive information about the agentand/or its use in the methods described herein. Of course, theinformational material can also be provided in any combination offormats.

In addition to the agent, the composition of the kit can include otheringredients, such as a solvent or buffer, a stabilizer, a preservative,and/or a second agent for treating a condition or disorder describedherein. Alternatively, the other ingredients can be included in the kit,but in different compositions or containers than the agent. In suchembodiments, the kit can include instructions for admixing the agent andthe other ingredients, or for using the agent together with the otheringredients.

The agent can be provided in any form, e.g., liquid, dried orlyophilized form. It is preferred that the agent be substantially pureand/or sterile. When the agent is provided in a liquid solution, theliquid solution preferably is an aqueous solution, with a sterileaqueous solution being preferred. When the agent is provided as a driedform, reconstitution generally is by the addition of a suitable solvent.The solvent, e.g., sterile water or buffer, can optionally be providedin the kit.

The kit can include one or more containers for the compositioncontaining the agent. In some embodiments, the kit contains separatecontainers, dividers or compartments for the composition andinformational material. For example, the composition can be contained ina bottle, vial, or syringe, and the informational material can becontained in a plastic sleeve or packet. In other embodiments, theseparate elements of the kit are contained within a single, undividedcontainer. For example, the composition is contained in a bottle, vialor syringe that has attached thereto the informational material in theform of a label. In some embodiments, the kit includes a plurality(e.g., a pack) of individual containers, each containing one or moreunit dosage forms (e.g., a dosage form described herein) of the agent.For example, the kit includes a plurality of syringes, ampules, foilpackets, or blister packs, each containing a single unit dose of theagent. The containers of the kits can be air tight and/or waterproof Thekit optionally includes a device suitable for administration of thecomposition, e.g., a stent, syringe, or any useful delivery device. In apreferred embodiment, the device is a stent.

Generation of Variants: Production of Altered DNA and Peptide Sequencesby Random Methods

Amino acid sequence variants of SERCA or fragments thereof can beprepared by a number of techniques, such as random mutagenesis of DNAwhich encodes a SERCA or a region thereof. Useful methods also includePCR mutagenesis and saturation mutagenesis. A library of random aminoacid sequence variants can also be generated by the synthesis of a setof degenerate oligonucleotide sequences.

PCR Mutagenesis

In PCR mutagenesis, reduced Taq polymerase fidelity is used to introducerandom mutations into a cloned fragment of DNA (Leung et al., 1989,Technique 1:11-15). This is a very powerful and relatively rapid methodof introducing random mutations. The DNA region to be mutagenized isamplified using the polymerase chain reaction (PCR) under conditionsthat reduce the fidelity of DNA synthesis by Taq DNA polymerase, e.g.,by using a dGTP/dATP ratio of five and adding Mn²⁺ to the PCR reaction.The pool of amplified DNA fragments are inserted into appropriatecloning vectors to provide random mutant libraries.

Saturation Mutagenesis

Saturation mutagenesis allows for the rapid introduction of a largenumber of single base substitutions into cloned DNA fragments (Mayers etal., 1985, Science 229:242). This technique includes generation ofmutations, e.g., by chemical treatment or irradiation of single-strandedDNA in vitro, and synthesis of a complimentary DNA strand. The mutationfrequency can be modulated by modulating the severity of the treatment,and essentially all possible base substitutions can be obtained. Becausethis procedure does not involve a genetic selection for mutant fragmentsboth neutral substitutions, as well as those that alter function, areobtained. The distribution of point mutations is not biased towardconserved sequence elements.

Degenerate Oligonucleotides

A library of homologs can also be generated from a set of degenerateoligonucleotide sequences. Chemical synthesis of a degenerate sequencescan be carried out in an automatic DNA synthesizer, and the syntheticgenes then ligated into an appropriate expression vector. The synthesisof degenerate oligonucleotides is known in the art (see for example,Narang, S A (1983) Tetrahedron 39:3; Itakura et al. (1981) RecombinantDNA, Proc 3rd Cleveland Sympos. Macromolecules, ed. A G Walton,Amsterdam: Elsevier pp273-289; Itakura et al. (1984) Annu. Rev. Biochem.53:323; Itakura et al. (1984) Science 198:1056; lke et al. (1983)Nucleic Acid Res. 11:477. Such techniques have been employed in thedirected evolution of other proteins (see, for example, Scott et al.(1990) Science 249:386-390; Roberts et al. (1992) PNAS 89:2429-2433;Devlin et al. (1990) Science 249: 404-406; Cwirla et al. (1990) PNAS 87:6378-6382; as well as U.S. Pat. Nos. 5,223,409, 5,198,346, and5,096,815).

Generation of Variants: Production of Altered DNA and Peptide Sequencesby Directed Mutagenesis

Non-random or directed mutagenesis techniques can be used to providespecific sequences or mutations in specific regions. These techniquescan be used to create variants that include, e.g., deletions,insertions, or substitutions, of residues of the known amino acidsequence of a protein. The sites for mutation can be modifiedindividually or in series, e.g., by (1) substituting first withconserved amino acids and then with more radical choices depending uponresults achieved, (2) deleting the target residue, or (3) insertingresidues of the same or a different class adjacent to the located site,or combinations of options 1-3.

Alanine Scanning Mutagnesis

Alanine scanning mutagenesis is a useful method for identification ofcertain residues or regions of the desired protein that are preferredlocations or domains for mutagenesis, Cunningham and Wells (Science244:1081-1085, 1989). In alanine scanning, a residue or group of targetresidues are identified (e.g., charged residues such as Arg, Asp, His,Lys, and Glu) and replaced by a neutral or negatively charged amino acid(most preferably alanine or polyalanine). Replacement of an amino acidcan affect the interaction of the amino acids with the surroundingaqueous environment in or outside the cell. Those domains demonstratingfunctional sensitivity to the substitutions are then refined byintroducing further or other variants at or for the sites ofsubstitution. Thus, while the site for introducing an amino acidsequence variation is predetermined, the nature of the mutation per seneed not be predetermined. For example, to optimize the performance of amutation at a given site, alanine scanning or random mutagenesis may beconducted at the target codon or region and the expressed desiredprotein subunit variants are screened for the optimal combination ofdesired activity.

Oligonucleotide-Mediated Mutagenesis

Oligonucleotide-mediated mutagenesis is a useful method for preparingsubstitution, deletion, and insertion variants of DNA, see, e.g.,Adelman et al., (DNA 2:183, 1983). Briefly, the desired DNA is alteredby hybridizing an oligonucleotide encoding a mutation to a DNA template,where the template is the single-stranded form of a plasmid orbacteriophage containing the unaltered or native DNA sequence of thedesired protein. After hybridization, a DNA polymerase is used tosynthesize an entire second complementary strand of the template thatwill thus incorporate the oligonucleotide primer, and will code for theselected alteration in the desired protein DNA. Generally,oligonucleotides of at least 25 nucleotides in length are used. Anoptimal oligonucleotide will have 12 to 15 nucleotides that arecompletely complementary to the template on either side of thenucleotide(s) coding for the mutation. This ensures that theoligonucleotide will hybridize properly to the single-stranded DNAtemplate molecule. The oligonucleotides are readily synthesized usingtechniques known in the art such as that described by Crea et al. (Proc.Natl. Acad. Sci. (1978) USA, 75: 5765).

Cassette Mutagenesis

Another method for preparing variants, cassette mutagenesis, is based onthe technique described by Wells et al. (Gene, 34:315[1985]). Thestarting material is aplasmid (or other vector) which includes theprotein subunit DNA to be mutated. The codon(s) in the protein subunitDNA to be mutated are identified. There must be a unique restrictionendonuclease site on each side of the identified mutation site(s). If nosuch restriction sites exist, they may be generated using theabove-described oligonucleotide-mediated mutagenesis method to introducethem at appropriate locations in the desired protein subunit DNA. Afterthe restriction sites have been introduced into the plasmid, the plasmidis cut at these sites to linearize it. A double-stranded oligonucleotideencoding the sequence of the DNA between the restriction sites butcontaining the desired mutation(s) is synthesized using standardprocedures. The two strands are synthesized separately and thenhybridized together using standard techniques. This double-strandedoligonucleotide is referred to as the cassette. This cassette isdesigned to have 3′ and 5′ ends that are comparable with the ends of thelinearized plasmid, such that it can be directly ligated to the plasmid.This plasmid now contains the mutated desired protein subunit DNAsequence.

Combinatorial Mutagenesis

Combinatorial mutagenesis can also be used to generate variants. Forexample, the amino acid sequences for a group of homologs or otherrelated proteins are aligned, preferably to promote the highest homologypossible. All of the amino acids which appear at a given position of thealigned sequences can be selected to create a degenerate set ofcombinatorial sequences. The variegated library of variants is generatedby combinatorial mutagenesis at the nucleic acid level, and is encodedby a variegated gene library. For example, a mixture of syntheticoligonucleotides can be enzymatically ligated into gene sequences suchthat the degenerate set of potential sequences are expressible asindividual peptides, or alternatively, as a set of larger fusionproteins containing the set of degenerate sequences.

Primary High-Through-Put Methods for Screening Libraries of PeptideFragments or Homologs

Various techniques are known in the art for screening peptides, e.g.,synthetic peptides, e.g., small molecular weight peptides (e.g., linearor cyclic peptides) or generated mutant gene products. Techniques forscreening large gene libraries often include cloning the gene libraryinto replicable expression vectors, transforming appropriate cells withthe resulting library of vectors, and expressing the genes underconditions in which detection of a desired activity, assembly into atrimeric molecules, binding to natural ligands, e.g., a receptor orsubstrates, facilitates relatively easy isolation of the vector encodingthe gene whose product was detected. Each of the techniques describedbelow is amenable to high through-put analysis for screening largenumbers of sequences created, e.g., by random mutagenesis techniques.

Two Hybrid Systems

Two hybrid (interaction trap) assays can be used to identify a proteinthat interacts with SERCA. These may include, e.g., agonists,superagonists, and antagonists of SERCA. (The subject protein and aprotein it interacts with are used as the bait protein and fishproteins.). These assays rely on detecting the reconstitution of afunctional transcriptional activator mediated by protein-proteininteractions with a bait protein. In particular, these assays make useof chimeric genes which express hybrid proteins. The first hybridcomprises a DNA-binding domain fused to the bait protein. e.g., SERCA oractive fragments thereof. The second hybrid protein contains atranscriptional activation domain fused to a “fish” protein, e.g. anexpression library. If the fish and bait proteins are able to interact,they bring into close proximity the DNA-binding and transcriptionalactivator domains. This proximity is sufficient to cause transcriptionof a reporter gene which is operably linked to a transcriptionalregulatory site which is recognized by the DNA binding domain, andexpression of the marker gene can be detected and used to score for theinteraction of the bait protein with another protein.

Display Libraries

In one approach to screening assays, the candidate peptides aredisplayed on the surface of a cell or viral particle, and the ability ofparticular cells or viral particles to bind an appropriate receptorprotein via the displayed product is detected in a “panning assay”. Forexample, the gene library can be cloned into the gene for a surfacemembrane protein of a bacterial cell, and the resulting fusion proteindetected by panning (Ladner et al., WO 88/06630; Fuchs et al. (1991)Bio/Technology 9:1370-1371; and Goward et al. (1992) TIBS 18:136-140).This technique was used in Sahu et al. (1996) J. Immunology 157:884-891,to isolate a complement inhibitor. In a similar fashion, a detectablylabeled ligand can be used to score for potentially functional peptidehomologs. Fluorescently labeled ligands, e.g., receptors, can be used todetect homolog which retain ligand-binding activity. The use offluorescently labeled ligands, allows cells to be visually inspected andseparated under a fluorescence microscope, or, where the morphology ofthe cell permits, to be separated by a fluorescence-activated cellsorter.

A gene library can be expressed as a fusion protein on the surface of aviral particle. For instance, in the filamentous phage system, foreignpeptide sequences can be expressed on the surface of infectious phage,thereby conferring two significant benefits. First, since these phagecan be applied to affinity matrices at concentrations well over 10¹³phage per milliliter, a large number of phage can be screened at onetime. Second, since each infectious phage displays a gene product on itssurface, if a particular phage is recovered from an affinity matrix inlow yield, the phage can be amplified by another round of infection. Thegroup of almost identical E. coli filamentous phages M13, fd., and flare most often used in phage display libraries. Either of the phage gIIIor gVIII coat proteins can be used to generate fusion proteins withoutdisrupting the ultimate packaging of the viral particle. Foreignepitopes can be expressed at the NH₂-terminal end of pIlI and phagebearing such epitopes recovered from a large excess of phage lackingthis epitope (Ladner et al. PCT publication WO 90/02909; Garrard et al.,PCT publication WO 92/09690; Marks et al. (1992) J. Biol. Chem.267:16007-16010; Griffiths et al. (1993) EMBO J 12:725-734; Clackson etal. (1991) Nature 352:624-628; and Barbas et al. (1992) PNAS89:4457-4461).

A common approach uses the maltose receptor of E. coli (the outermembrane protein, LamB) as a peptide fusion partner (Charbit et al.(1986) EMBO 5, 3029-3037). Oligonucleotides have been inserted intoplasmids encoding the LamB gene to produce peptides fused into one ofthe extracellular loops of the protein. These peptides are available forbinding to ligands, e.g., to antibodies, and can elicit an immuneresponse when the cells are administered to animals. Other cell surfaceproteins, e.g., OmpA (Schorr et al. (1991) Vaccines 91, pp. 387-392),PhoE (Agterberg, et al. (1990) Gene 88, 37-45), and PAL (Fuchs et al.(1991) Bio/Tech 9, 1369-1372), as well as large bacterial surfacestructures have served as vehicles for peptide display. Peptides can befused to pilin, a protein which polymerizes to form the pilus-a conduitfor interbacterial exchange of genetic information (Thiry et al. (1989)Appl. Environ. Microbiol. 55, 984-993). Because of its role ininteracting with other cells, the pilus provides a useful support forthe presentation of peptides to the extracellular environment. Anotherlarge surface structure used for peptide display is the bacterial motiveorgan, the flagellum. Fusion of peptides to the subunit proteinflagellin offers a dense array of may peptides copies on the host cells(Kuwajima et al. (1988) Bio/Tech. 6, 1080-1083). Surface proteins ofother bacterial species have also served as peptide fusion partners.Examples include the Staphylococcus protein A and the outer membraneprotease IgA of Neisseria (Hansson et al. (1992) J. Bacteriol. 174,4239-4245 and Klauser et al. (1990) EMBO J. 9, 1991-1999).

In the filamentous phage systems and the LamB system described above,the physical link between the peptide and its encoding DNA occurs by thecontainment of the DNA within a particle (cell or phage) that carriesthe peptide on its surface. Capturing the peptide captures the particleand the DNA within. An alternative scheme uses the DNA-binding proteinLacI to form a link between peptide and DNA (Cull et al. (1992) PNAS USA89:1865-1869). This system uses a plasmid containing the LacI gene withan oligonucleotide cloning site at its 3′-end. Under the controlledinduction by arabinose, a LacI-peptide fusion protein is produced. Thisfusion retains the natural ability of LacI to bind to a short DNAsequence known as LacO operator (LacO). By installing two copies of LacOon the expression plasmid, the LacI-peptide fusion binds tightly to theplasmid that encoded it. Because the plasmids in each cell contain onlya single oligonucleotide sequence and each cell expresses only a singlepeptide sequence, the peptides become specifically and stably associatedwith the DNA sequence that directed its synthesis. The cells of thelibrary are gently lysed and the peptide-DNA complexes are exposed to amatrix of immobilized receptor to recover the complexes containingactive peptides. The associated plasmid DNA is then reintroduced intocells for amplification and DNA sequencing to determine the identity ofthe peptide ligands. As a demonstration of the practical utility of themethod, a large random library of dodecapeptides was made and selectedon a monoclonal antibody raised against the opioid peptide dynorphin B.A cohort of peptides was recovered, all related by a consensus sequencecorresponding to a six-residue portion of dynorphin B. (Cull et al.(1992) Proc. Natl. Acad. Sci. U.S.A. 89-1869)

This scheme, sometimes referred to as peptides-on-plasmids, differs intwo important ways from the phage display methods. First, the peptidesare attached to the C-terminus of the fusion protein, resulting in thedisplay of the library members as peptides having free carboxy termini.Both of the filamentous phage coat proteins, pIII and pVIII, areanchored to the phage through their C-termini, and the guest peptidesare placed into the outward-extending N-terminal domains. In somedesigns, the phage-displayed peptides are presented right at the aminoterminus of the fusion protein. (Cwirla, et al. (1990) Proc. Natl. Acad.Sci. U.S.A. 87, 6378-6382) A second difference is the set of biologicalbiases affecting the population of peptides actually present in thelibraries. The LacI fusion molecules are confined to the cytoplasm ofthe host cells. The phage coat fusions are exposed briefly to thecytoplasm during translation but are rapidly secreted through the innermembrane into the periplasmic compartment, remaining anchored in themembrane by their C-terminal hydrophobic domains, with the N-termini,containing the peptides, protruding into the periplasm while awaitingassembly into phage particles. The peptides in the LacI and phagelibraries may differ significantly as a result of their exposure todifferent proteolytic activities. The phage coat proteins requiretransport across the inner membrane and signal peptidase processing as aprelude to incorporation into phage. Certain peptides exert adeleterious effect on these processes and are underrepresented in thelibraries (Gallop et al. (1994) J. Med. Chem. 37(9):1233-1251). Theseparticular biases are not a factor in the LacI display system.

The number of small peptides available in recombinant random librariesis enormous. Libraries of 107-109 independent clones are routinelyprepared. Libraries as large as 10¹¹ recombinants have been created, butthis size approaches the practical limit for clone libraries. Thislimitation in library size occurs at the step of transforming the DNAcontaining randomized segments into the host bacterial cells. Tocircumvent this limitation, an in vitro system based on the display ofnascent peptides in polysome complexes has recently been developed. Thisdisplay library method has the potential of producing libraries 3-6orders of magnitude larger than the currently available phage/phagemidor plasmid libraries. Furthermore, the construction of the libraries,expression of the peptides, and screening, is done in an entirelycell-free format.

In one application of this method (Gallop et al. (1994) J. Med. Chem.37(9):1233-1251), a molecular DNA library encoding 10¹² decapeptides wasconstructed and the library expressed in an E. coli S30 in vitro coupledtranscription/translation system. Conditions were chosen to stall theribosomes on the mRNA, causing the accumulation of a substantialproportion of the RNA in polysomes and yielding complexes containingnascent peptides still linked to their encoding RNA. The polysomes aresufficiently robust to be affinity purified on immobilized receptors inmuch the same way as the more conventional recombinant peptide displaylibraries are screened. RNA from the bound complexes is recovered,converted to cDNA, and amplified by PCR to produce a template for thenext round of synthesis and screening. The polysome display method canbe coupled to the phage display system. Following several rounds ofscreening, cDNA from the enriched pool of polysomes was cloned into aphagemid vector. This vector serves as both a peptide expression vector,displaying peptides fused to the coat proteins, and as a DNA sequencingvector for peptide identification. By expressing the polysome-derivedpeptides on phage, one can either continue the affinity selectionprocedure in this format or assay the peptides on individual clones forbinding activity in a phage ELISA, or for binding specificity in acompletion phage ELISA (Barret, et al. (1992) Anal. Biochem204,357-364). To identify the sequences of the active peptides onesequences the DNA produced by the phagemid host.

For example, one or more residues (e.g., between one and six residues orone and three residues) in a SERCA protein can differ from wild-type orcan be deleted. For example, the N-terminal first and/or second residue(e.g., after removal of a signal sequence) can be deleted, and theC-terminal-most first and/or second residue can be deleted. Selectedtransmembrane residues can be altered, e.g., with similar hydrophobicresidues. The protein may include other substitutions, e.g.,conservative substitutions. A “conservative amino acid substitution” isone in which the amino acid residue is replaced with an amino acidresidue having a similar side chain. Families of amino acid residueshaving similar side chains have been defined in the art. These familiesinclude amino acids with basic side chains (e.g., lysine, arginine,histidine), acidic side chains (e.g., aspartic acid, glutamic acid),uncharged polar side chains (e.g., glycine, asparagine, glutamine,serine, threonine, tyrosine, cysteine), nonpolar side chains (e.g.,alanine, valine, leucine, isoleucine, proline, phenylalanine,methionine, tryptophan), beta-branched side chains (e.g., threonine,valine, isoleucine) and aromatic side chains (e.g., tyrosine,phenylalanine, tryptophan, histidine). It is possible for many frameworkand CDR amino acid residues to include one or more conservativesubstitutions.

Secondary Screens for Inhibitors of the Alternative Pathway

The high through-put assays described above can be followed (orsubstituted) by secondary screens, e.g., the following screens, in orderto identify biological activities which will, e.g., allow one skilled inthe art to differentiate agonists from antagonists. The type of asecondary screen used will depend on the desired activity that needs tobe tested. Several such assays are described below. For example, anassay can be developed in which the ability to increase or mimic SERCAactivity can be used to identify SERCA agonists from a group of peptidefragments isolated though one of the primary screens described above.

Binding Assays

SERCA can bind to a SERCA binding partner, e.g., phospholamban orsarcolipin. The ability of a SERCA variant to bind a binding partner,e.g., phospholamban or sarcolipin, is an assayable activity of SERCAfinction. In addition, a binding assay, e.g., a binding assay describedherein, can be used to evaluate: (a) the ability of a test agent to bindSERCA; (b) the ability of a test agent to inhibit binding of SERCA to abinding partner, e.g., the ability of a test agent to inhibit or disruptSERCA binding to phospholamban or sarcolipin; the ability of a testagent to stabilize or increase binding of a complement component to abinding partner, e.g., the ability of a test agent to stabilize orincrease SERCA binding to phospholamban or sarcolipin.

As SERCA, e.g., human SERCA, has been cloned and produced recombinantly,it is readily available as a reagent to be used in standard bindingassays known in the art, which include, but are not limited to: affinitychromatography, size exclusion chromatography, gel filtration, fluidphase binding assay; ELISA (e.g., competition ELISA),immunoprecipitation.

Peptide Mimetics

The invention also provides for production of domains of SERCA, togenerate mimetics, e.g. peptide or non-peptide agents, e.g., agonists.

Non-hydrolyzable peptide analogs of critical residues can be generatedusing benzodiazepine (e.g., see Freidinger et al. in Peptides: Chemistryand Biology, G. R. Marshall ed., ESCOM Publisher: Leiden, Netherlands,1988), azepine (e.g., see Huffman et al. in Peptides: Chemistry andBiology, G. R. Marshall ed., ESCOM Publisher: Leiden, Netherlands,1988), substituted gama lactam rings (Garvey et al. in Peptides:Chemistry and Biology, G. R. Marshall ed., ESCOM Publisher: Leiden,Netherlands, 1988), keto-methylene pseudopeptides (Ewenson et al. (1986)J Med Chem 29:295; and Ewenson et al. in Peptides: Structure andFunction (Proceedings of the 9th American Peptide Symposium) PierceChemical Co. Rockland, Ill., 1985), b-turn dipeptide cores (Nagai et al.(1985) Tetrahedron Lett 26:647; and Sato et al. (1986) J Chem Soc PerkinTrans 1:1231), and b-aminoalcohols (Gordon et al. (1985) Biochem BiophysRes Commun126:419; and Dann et al. (1986) Biochem Biophys Res Commun134:71). -ps Exemplary Modes of Administration

An agent that modulates SERCA signaling, e.g., an agent describedherein, can be administered to a subject by standard methods. Forexample, the agent can be administered by any of a number of differentroutes including by introduction into a lumen of the circulatory system,e.g., the lumen of an artery, vein, or organ, e.g., the heart. Inanother embodiment, the agent is administered by injection, e.g.,intra-arterially, intramuscularly, or intravenously. The agent can bepackaged in a viral particle, and formulated with materials compatiblewith maintaining ability of the viral particle to introduce the nucleicacid into a cell, e.g., when the viral particle is introduced into asubject.

The agent, e.g., a SERCA nucleic acid molecule, polypeptide, fragmentsor analog, modulators (e.g., organic compounds and antibodies (alsoreferred to herein as “active compounds”) can be incorporated intopharmaceutical compositions suitable for administration to a subject,e.g., a human. Such compositions typically include the polypeptide,nucleic acid molecule, modulator, or antibody and a pharmaceuticallyacceptable carrier. As used herein the language “pharmaceuticallyacceptable carrier” is intended to include any and all solvents,dispersion media, coatings, antibacterial and antifungal agents,isotonic and absorption delaying agents, and the like, compatible withpharmaceutical administration. The use of such media and agents forpharmaceutically active substances are known. Except insofar as anyconventional media or agent is incompatible with the active compound,such media can be used in the compositions of the invention.Supplementary active compounds can also be incorporated into thecompositions.

A pharmaceutical composition can be formulated to be compatible with itsintended route of administration. Solutions or suspensions used forparenteral, intradermal, or subcutaneous application can include thefollowing components: a sterile diluent such as water for injection,saline solution, fixed oils, polyethylene glycols, glycerine, propyleneglycol or other synthetic solvents; antibacterial agents such as benzylalcohol or methyl parabens; antioxidants such as ascorbic acid or sodiumbisulfite; chelating agents such as ethylenediaminetetraacetic acid;buffers such as acetates, citrates or phosphates and agents for theadjustment of tonicity such as sodium chloride or dextrose. pH can beadjusted with acids or bases, such as hydrochloric acid or sodiumhydroxide. The parenteral preparation can be enclosed in ampoules,disposable syringes or multiple dose vials made of glass or plastic.

Pharmaceutical compositions suitable for injectable use include sterileaqueous solutions (where water soluble) or dispersions and sterilepowders for the extemporaneous preparation of sterile injectablesolutions or dispersion. For intravenous administration, suitablecarriers include physiological saline, bacteriostatic water, CremophorEL™ (BASF, Parsippany, N.J.) or phosphate buffered saline (PBS). In allcases, the composition must be sterile and should be fluid to the extentthat easy syringability exists. It must be stable under the conditionsof manufacture and storage and must be preserved against thecontaminating action of microorganisms such as bacteria and fungi. Thecarrier can be a solvent or dispersion medium containing, for example,water, ethanol, polyol (for example, glycerol, propylene glycol, andliquid polyethylene glycol, and the like), and suitable mixturesthereof. The proper fluidity can be maintained, for example, by the useof a coating such as lecithin, by the maintenance of the requiredparticle size in the case of dispersion and by the use of surfactants.Prevention of the action of microorganisms can be achieved by variousantibacterial and antifungal agents, for example, parabens,chlorobutanol, phenol, ascorbic acid, thimerosal, and the like. In manycases, it will be preferable to include isotonic agents, for example,sugars, polyalcohols such as manitol, sorbitol, sodium chloride in thecomposition. Prolonged absorption of the injectable compositions can bebrought about by including in the composition an agent which delaysabsorption, for example, aluminum monostearate and gelatin.

Sterile injectable solutions can be prepared by incorporating the activecompound (e.g., an agent described herein) in the required amount in anappropriate solvent with one or a combination of ingredients enumeratedabove, as required, followed by filtered sterilization. Generally,dispersions are prepared by incorporating the active compound into asterile vehicle which contains a basic dispersion medium and therequired other ingredients from those enumerated above. In the case ofsterile powders for the preparation of sterile injectable solutions, thepreferred methods of preparation are vacuum drying and freeze-dryingwhich yields a powder of the active ingredient plus any additionaldesired ingredient from a previously sterile-filtered solution thereof.

In one embodiment, the active compounds are prepared with carriers thatwill protect the compound against rapid elimination from the body, suchas a controlled release formulation, including implants andmicroencapsulated delivery systems. Biodegradable, biocompatiblepolymers can be used, such as ethylene vinyl acetate, polyanhydrides,polyglycolic acid, collagen, polyorthoesters, and polylactic acid.Methods for preparation of such formulations will be apparent to thoseskilled in the art. The materials can also be obtained commercially fromAlza Corporation and Nova Pharmaceuticals, Inc. Liposomal suspensions(including liposomes targeted to infected cells with monoclonalantibodies to viral antigens) can also be used as pharmaceuticallyacceptable carriers. These can be prepared according to methods known tothose skilled in the art, for example, as described in U.S. Pat. No.4,522,811.

The pharmaceutical compositions can be included in a container, pack, ordispenser together with instructions for administration.

In a preferred embodiment, the pharmaceutical composition is injectedinto an affected vessel, e.g., an artery, e.g., a coronary artery. Inanother embodiment, the pharmaceutical composition is delivered inassociation with a medical device that is introduced into an affectedvessel, e.g., a stent that is introduced into the affected vessel.Additional exemplary modes of administration are described, e.g., inU.S. Ser. No. 10/914,829.

Although methods and materials similar or equivalent to those describedherein can be used in the practice or testing of the present invention,suitable methods and materials are described below. All publications,patent applications, patents, and other references mentioned herein areincorporated by reference in their entirety. In case of conflict, thepresent specification, including definitions, will control. In addition,the materials, methods, and examples are illustrative only and notintended to be limiting.

Other features and advantages of the invention will be apparent from thefollowing detailed description, the drawings, and the claims.

EXAMPLES Example 1 SERCA 2a Expression in Growing VSMC InhibitsProliferation

Rat aortic SMC were isolated from the media of the thoracic aorta frommale Wistar rats as and cultured in DMEM supplemented with 1%penicillin-streptomycin-amphotericin mixture (ICN) and 10% fetal calfserum (FCS). At confluence they were passaged using trypsin. Cellsbetween passage 2 to 8 were used.

The rat VSMC were infected with adenovirus SERCA2a vector essentially asdescribed in del Monte et al., 2001, Circulation 104:1424. Briefly,human SERCA2a cDNA was subcloned into the adenoviral shuttle vector(pAd.TRACK), which uses the cytomegalovirus (CMV) long terminal repeatas a promoter to make Ad-S2a vector. The shuttle vector used also has aconcomitant green fluorescent protein (GFP) under the control of aseparate CMV promoter. An adenovirus containing both β-galactosidase andGFP controlled by separate CMV promoters (Ad-βBGal-GFP) was used ascontrol. The adenoviruses were propagated in 293 cells. The recombinantadenoviruses were tested for the absence of wild-type virus bypolymerase chain reaction of the early transcriptional unit E1.

Adenoviral infection was followed by monitoring the fluorescence of GFP.Significant increase in fluorescence was observed 4 days after infection(FIG. 2A). Control cells as well as Ad-pGal-GFP infected cells did notexpress SERCA 2a. A high amount of SERCA 2a was present in AdS2a-infected cells without much change in the level of SERCA 2b (FIG.2B).

Proliferation of VSMC was measured by using the colorimetric-basedCELLTITER96® Cell Proliferation Assay kit (Promega) according tomanufacturer instructions. Between day 0 and day 4, the number of cellsin control conditions and in cells infected with Ad βgal had increased 5times whereas the number of Ad S2a-infected cells increasedsignificantly less (p<0.01) (FIG. 2C), indicating that SERCA 2a preventsVSMC proliferation. This was also confirmed by immunolabelling witha-PCNA (FIG. 2D). Indeed, the cell labelled with a-SERCA 2a did notexpress PCNA, a marker of S phase, whereas PCNA was present innon-infected cells or in cells infected with Ad-βGal.

Accordingly, SERCA 2a prevents VSMC proliferation in vitro.

Example 2 SERCA 2a Expression Blocks the Cell Cycle at the G1 Phase andPrevents Entry in the S Phase

The absence of PCNA in Ad-S2a-infected cells indicated that the cellsdid not enter the S phase.

VSMCs were harvested by trypsinization and stained with propidium iodideand the DNA content and cell cycle were determined. Fluorescence of thenuclei after labelling with propidium iodide was analysed using aflowcytometer. In the control situation and in Ad-βGal-GFP infectedcells the percentage of S gated events was approximately 50% and 46%respectively, whereas it was only approximately 30% in Ad-S2a-infectedcells. No cells were in the subG1, indicating the absence of apoptosis.

Example 3 SERCA 2a Expression Prevents NFAT Activation

SERCA2a overexpression inhibits smooth muscle activation of NFAT andcalcineurin, downstream markers of hypertrophy and proliferation (FIG.3)

Example 4 Adenovirus-mediated Expression of SERCA2a in Balloon-injuredRat Carotid Arteries Decreases Restenosis

Balloon injured rat carotid arteries were infected with 10¹⁰ pfu Ad-S2a(n=4) or Ad-βGal-GFP (control virus). Fourteen days after infection,quantitative morphometry was performed on 5-μm sections from thetransduced segment by an investigator blinded to the experimentalprocedure.

At fourteen days after balloon injury and infection, the intima/mediaratio was significantly lower in arteries infected with Ad-S2a(0.16±0.08) than in control infected arteries (0.73±0.12). P<0.05 forboth.

Example 5 Other Methods

Western blot analysis and immunofluorescence: Total cell lysates wereprepared according to standard protocol (Upstate biotechnology,Technical Support). Cytosolic and nuclear fractions were obtained byhypotonic lysis. The protein content was determined by using BradfordProtein Assay Reagent Kit (Bio-Rad). Lysates were matched for proteinconcentration, resolved by SDS-PAGE and transferred to Hybond-C(Amersham). The primary antibody was a-NFATc1 from Santa CruzBiotechnology, Inc (K-18). Proteins were visualized using a goatanti-rabbit secondary antibody conjugated to horseradish peroxidase andenhanced chemiluminescence's detection system (ECL+, Amersham).

Immunofluorescence: immunofluorescence was performed on cell culture orcryosections for the carotid artery. Proteins were visualized by usingeither secondary antibodies directly conjugated to Texas Red or thebiotin/streptavidin-Texas Red conjugated amplification method(Amersham). Antibodies to SERCA 2a and 2b were previously described.Anti-PCNA (proliferating nuclear antigen) was from Abcam (UK), a-GFP anda-NFATc1 (K-18) were from Santa-Cruz. Nuclei were stained with Hoechst.Images were collected with a Zeiss LSM-510 confocal scanning lasermicroscope equipped with a 25 mW Argon laser and a 1 mW Helium-Neonlaser, using a Plan Apochromat 63× objective (NA 1.40, oil immersion).Green fluorescence was observed with a 505-550 nm band-pass emissionfilter under 488 nm laser illumination and red fluorescence was observedwith a 560 long-pass emission filter under 543 nm laser illumination.Pinholes are set at 1.0 Airy unit. Stacks of images were collected every0.4 μm along the z-axis. Hoescht detection is done using the HBO mercurylamp (50W) and a set filter 01 (excitation BP 365/12, beamsplitter FT395, emission LP 397). All settings were kept constant for comparison.For double immunofluorescence, dual excitation using the multitrack mode(images taken sequentially), was achieve using the Argon and He/Nelasers respectively.

Intracellular [Ca2+]i measurements: Cells were loaded with 4 μmol/L Fura2 (Molecular Probes) and continously superfused with control or testsolutions at 37° C. using a PTR 200 perfusion temperature regulator (ALAScientific Instruments, Westbury, N.Y., USA). The control solutioncontained (mmol/L): NaCl, 116; KCL, 5.6; CaCl2, 1.8; MgCl2, 1.2; NaHCO3,5; NaH2PO4, 1; HEPES, 20; pH 7.3. Caffeine (10 mmol/L), ATP (1, 10 and100 μmol/L) or 2,5-di-(t-butyl)-1,4-benzo-hydroquinone (tBHQ, 50 μmol/L)were used in the test solution. The excitation light was supplied by ahigh pressure 100 W xenon arc lamp and the 340 and 380 μm wavelengthsselected by a monochromator (Cairn Research Ltd, Faversham, Kent, UK).Fluorescence images were collected every 2 seconds by a Sensicam QE CCDcamera (PCO Computer Optics GmbH, Kelheim, Germany), digitized, andintegrated in real time by an image processor (Metafluor, Princeton,N.J., USA). 340 and 380 background fluorescence signals were collectedat the same rate and subsequently subtracted from respective fluorescentimages. Results (ΔF/F) were expressed as ratios between 340 and 380fluorescence signals measured during a response divided by the ratiomeasured in resting conditions, i.e. before the addition of an agent.

DNA binding assay: Electromobility shift assay was performed using 0.5ng of ³²P-labelled double-stranded NFAT probe (NFATc gel shiftoligonucleotide, Santa Cruz, sc-2577) and 15 μg of nuclear extracts.Reaction mixtures were subjected to electrophoresis on a 5%polyacrylamide gel in non-denaturing conditions.

Example 6

We evaluated the effect of SERCA2a gene transfer on blood vessels inrats after balloon injury. We found that, compared to controls, SERCA2agene transfer can prevent formation of a neointima.

Methods.

Balloon injury. After the left external carotid artery was exposed andheparin (35 IU) was administered intraperiotoneally, a 2Fr Fogartyembolectomy catheter (Baxter Healthcare Corp) was introduced into anexternal carotid arteriotomy incision, advanced to the common carotidartery, and inflated at 2 atmosphere and withdrawn 3 times withrotation. The catheter was then removed, and a dwelling catheter wasintroduced into the arteriotomy site. After both the proximal commoncarotid artery and the proximal internal carotid artery were clamped,viral infusion mixtures with 1×10⁹ pfu of virus containing eitherSERCA2a or βgal diluted to a total volume of 100 μL was instilled viathe arterial segment between the 2 clamps, and the external carotidartery was then ligated. Perfusion was restored in the common carotidartery after 30 minutes of instillation, and the neck incision wasclosed using 3-0 silk sutures.

Histochemical analysis. The animals were sacrificed after 7 and 14 days.Both the right and left common carotids were dissected and included infrozen specimen embedding solution. Transversal cryosections wereperformed on the middle portion of the artery and longitudinal sectionson the proximal and distal portions. Hematoxylin-eosin staining wasperformed and the surface of lumen as well as the thickness of the mediaand intima were measured on at least 3-5 sections for different portionsof the arteries. Expression of SERCA 2a was analysed byimmunofluorescence using a rabbit antiS2a antibody followed by andanti-rabbit-TRITC secondary antibody.

Four groups were considered: 1) Non injured, non infected correspondingto the right carotids, 2) Injured, non-infected corresponding to theleft carotid were no GFP labelling could be detected, 3) Injured,infected with β-Gal and 4) injured infected with S2a. The left carotidsincluded in those two groups displayed clear GFP labelling on unfixedsections.

Results and Discussion

As shown in Table 2, there was no difference in the lumen area or in themedia thickness between groups. There was a tendency to the preventionof intimal thickening with S2a gene transfer but due to the small numberof animals this was not significant (FIG. 4). TABLE 2 Morphometricmeasurements. Lumen area (mm²) Media μm Intima μm Non injured, non- 1.46± 0.085  47.3 ± 4.67 8.46 ± 0.22 infected (n = 10) Injured, non-infected1.73 ± 0.114 41.26 ± 3.9 21.94 ± 7.28  (n = 4) Injured, infected β-Gal1.95 ± 0.1  45.54 ± 2.7 21.89 ± 7.7  (n = 4) Injured, infected S2a 1.8 ±0.23    45 ± 4.95 12.7 ± 1.82 (n = 6)

We evaluated expression of the S2a in control and infected arteries.Expression of S2a is visualized in red by confocal imaging on 0.8 μmoptical slices using a 63× oil immersion objective. In green is theauto-fluorescence of the elastin. The image were obtained using themultitrack mode with a He/Ne laser (ex: 543 nm-Em LP 560 nm) for the redfluorescence and with a Argon laser (Ex: 488nm-Em: bp 505-550) for thegreen fluorescence. DIC represents the same image in differentialinterferential contrast.

A high level of S2a was observed in the media of the control carotid.When the vessel is injured, the smooth muscle cells from the media startto proliferate and to migrate to the neointima. We found that low levelof S2a is observed in those cells, as seen in vitro. Infection withβ-gal adenovirus did not prevent proliferation but restoration of a highlevel of S2a clearly inhibits the formation of the neointima. Thedifferential interferential contrast image shows the adventitia which isnot labelled with a-S2a indicating the absence of background.

1. A method of treating restenosis, the method comprising: identifying asubject in need of treatment, or at risk, for restenosis; andadministering a nucleic acid that encodes a SERCA polypeptide in a bloodvessel of the subject.
 2. The method of claim 1, wherein the SERCApolypeptide is SERCA1a, SERCA1b, SERCA2a, SERCA2b or SERCA3 polypeptide.3. The method of claim 1, wherein the subject has undergone, isundergoing, or will undergo, percutaneous coronary intervention.
 4. Themethod of claim 1, wherein the subject has undergone, is undergoing, orwill undergo, angioplasty or balloon angioplasty.
 5. The method of claim1, wherein the subject has undergone, is undergoing, or will undergoinsertion of a stent.
 6. The method of claim 1, wherein the subject hasundergone, is undergoing, or will undergo, insertion of a prosthesis,insertion of a graft, insertion of a stent, catheterization, or arterialblockage evaluation.
 7. The method of claim 1, wherein the methodcomprises implanting in the vessel a stent coated with or containing theagent.
 8. The method of claim 1, wherein the agent is packaged in aviral particle.
 9. The method of claim 8, wherein the SERCA nucleic acidis a component of an adenovirus-based, adeno-associated virus-based,lentivirus-based or plasmid-based vector.
 10. The method of claim 9,wherein the vector compromises the nucleic acid encoding SERCA operablylinked to a viral or cardiac specific promoter.
 11. The method of claim9, wherein the vector compromises the nucleic acid encoding SERCAoperably linked to an inducible promoter.
 12. The method of claim 1,wherein the agent is administered in an amount effective to preventneointimal hyperplasia.
 13. A method of treating restenosis, the methodcomprising: identifying a subject having or at risk of having arestenotic vessel; and implanting in the vessel a stent coated with orcontaining a nucleic acid that encodes SERCA2a.
 14. The method of claim13 wherein the stent is coated with viral particles that include thenucleic acid that encodes SERCA.
 15. A method of treating acardiovascular disorder, the method comprising: implanting a stent thatis coated with or containing a nucleic acid that encodes SERCA in ablood vessel of a subject.
 16. The method of claim 15 wherein the stentis coated with viral particles that include the nucleic acid thatencodes SERCA.
 17. A method of treating a cardiovascular disorder, themethod comprising: introducing a nucleic acid that encodes SERCA intocells of a blood vessel; and implanting a stent in the blood vessel. 18.The method of claim 17 wherein the nucleic acid is introduced into thecells before the stent is implanted.
 19. The method of claim 17 whereinthe nucleic acid is introduced into the cell concurrent with implantingthe stent.
 20. The method of claim 17 wherein the nucleic acid isintroduced into the cells after the stent is implanted.
 21. A stentcoated with or containing an agent, the agent comprising a nucleic acidthat encodes a SERCA protein.
 22. The stent of claim 21, wherein theagent is a nucleic acid that encodes SERCA2a.
 23. The stent of claim 21,wherein the agent is packaged in a viral particle.
 24. A kit comprisinga stent coated with, or containing, an agent comprising a nucleic acidthat encodes a SERCA protein, and instructions for using the stent totreat restenosis.
 25. The kit of claim 24, wherein the agent is aSERCA2a encoding nucleic acid.